Patients undergoing small or large bowel resections often have underlying nutritional deficiencies due to their disease process. Further nutritional deprivation postoperatively has been associated with complications such as infection and decreased wound healing. At St. Luke's Episcopal Hospital, Houston, Texas (S.L.E.H.-H.), a digestive health services outcomes management program was created because the length of stay and cost per case for small and large bowel surgery patients exceeded the payment allowance for Medicare, Medicaid, and other managed care contracts. During the initial data gathering phase for this outcomes management program, it was noted that many of the patients undergoing bowel resection received no nutrition for five or more days postoperatively. The proposed project will test the hypothesis developed from empirical patient data that early nutrition intervention will decrease hospital cost and improve outcome for patients receiving small and large bowel resections at S.L.E.H. -H. The specific aim of this study is to implement a standardized early tube feeding protocol and evaluate its cost- effectiveness. Outcome measures to evaluate cost and quality of care will include length of stay, cost of care, nutritional status, complication rates (infection, ventilator support), and quality of life. A prospective quasi-experimental non-equivalent group comparison design will be used. The treatment group will include those patients receiving bowel resection by surgeons agreeing to implement the early postoperative feeding protocol. A prospective comparison group of patients not receiving the feeding protocol will serve as the control group. A constructed retrospective comparison group which includes all patients receiving bowel surgery during the year prior to the implementation of this study will be evaluated to define usual care. This data will be used to evaluate if any changes in treatment patterns occurred during the study period. The proposed research will contribute to our understanding of whether early postoperative nutrition reduces cost and improves patient outcome after bowel surgery. In 1991 diseases of the digestive system accounted for 10.5 percent of all discharges from non-Federal short-term hospitals. This study will provide practical cost-effectiveness and quality outcome data that can be applied to bowel surgery patients and related patient groups.